MEDICARE: CARDIOVASCULAR ASSOCIATES PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RC0000X	Cardiovascular Disease Physician

General Provider Information

NPI Number	:	1043284094
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CARDIOVASCULAR ASSOCIATES PC

Provider Business Mailing Address
First Line	:	5885 SUNNYBROOK DRIVE
Second Line	:	SUITE L-200
City	:	SIOUX CITY
State	:	IA
Zip	:	51106
Country	:	US
Telephone Number	:	712-239-4702
Fax Number	:	712-224-5898

Provider Business Practice Location Address
First Line	:	5885 SUNNYBROOK DRIVE
Second Line	:	SUITE L-200
City	:	SIOUX CITY
State	:	IA
Zip	:	51106
Country	:	US
Telephone Number	:	712-239-4702
Fax Number	:	712-224-5898

Authorized Official
Title or Position	:	COO
Name	:	PEGGY L HANNER
Credential	:
Telephone Number	:	712-239-4702

Provider Enumeration Date	:	02/15/2006
Last Update Date	:	02/22/2016

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